2017 Medicare Advantage MedMutual Advantage Preferred (PPO)

MedMutual Advantage Preferred (PPO) H4497-002 is a 2017 Medicare Advantage or Medicare Part-C plan by Medical Mutual of Ohio available to residents in Ohio. This plan includes additional Medicare prescription drug (Part-D) coverage. The MedMutual Advantage Preferred (PPO) has a monthly premium of $125.00 and has a in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $4,900 this can be a very nice safety net.

MedMutual Advantage Preferred (PPO) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Medical Mutual of Ohio works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for MedMutual Advantage Preferred (PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Medical Mutual of Ohio and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Medical Mutual of Ohio except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Part-C Premium

Medical Mutual of Ohio plan charges a $58.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

MedMutual Advantage Preferred (PPO) has a monthly drug premium of $67.00 and a $0.00 drug deductible. This Medical Mutual of Ohio plan offers a $67.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Medical Mutual of Ohio above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $67.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The MedMutual Advantage Preferred (PPO) medicare insurance offers a $34.70 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $42.80 for 75% low income subsidy $50.80 for 50% and $58.90 for 25%.

Part C Premium:

$58.00

Part D (Drug) Premium:

$67.00

Part D Supplemental Premium

$0.00

Total Part D Premium:

$67.00

Drug Deductible:

$0.00

Tiers with No Deductible:

0

Benchmark:

not below the regional benchmark

Type of Medicare Health:

Enhanced Alternative

Drug Benefit Type:

Enhanced

Full LIS Premium:

$34.70

75% LIS Premium:

$42.80

50% LIS Premium:

$50.80

25% LIS Premium:

$58.90

Initial Coverage Limit:

$3700

Gap Coverage:

Yes

Gap Coverage

In 2017 once you and your plan provider have spent $3700 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 40% for brand-name drugs and 51% on generic drugs unless your plan offers additional coverage. This Medical Mutual of Ohio plan does offer additional coverage through the gap.

Notes: Data are subject to change as contracts are finalized. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit

Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.